Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes.

The objective of this study was to compare the perioperative and short-term functional and oncological outcomes of single-port and multiport robotic-assisted laparoscopic partial nephrectomy using propensity-score analysis. We evaluated all patients who underwent robotic partial nephrectomy at our institution between January 2019 and October 2020. Patient demographics, intraoperative data, and postoperative outcomes were collected and analyzed. Propensity-score matching was performed on age, sex, body mass index, prior abdominal surgery, and nephrometry score using the optimal matching method. A post hoc sensitivity analysis was performed to examine the robustness of the results. In total, 48 and 238 patients underwent single-port and multiport robotic partial nephrectomy, respectively. Following propensity-score matching, 48 multiport cases were matched 1:1 to single-port cases. The single-port cohort had lower median opioid use at postoperative day 1 (4.6 vs 9.8 MME, p = 0.0209) and cumulative hospital stay (5.1 vs 9.3 MME, p = 0.0357). Single port also had a shorter median length of stay (1.4 vs 1.6 days, p = 0.0045), although the post hoc sensitivity analysis showed no difference between the groups [- 0.13 (95% CI; - 0.580, 0.315, p = 0.5607). There were no significant differences in operative time, estimated blood loss, ischemia time, transfusions received, or positive margin rates. In conclusion, based on our early experience, single-port robotic partial nephrectomy is a safe and acceptable alternative to multiport robotic partial nephrectomy, providing comparable perioperative and postoperative outcomes while reducing inpatient opioid use.

Propensity-Score Matched Analysis Between Extraperitoneal Single Port and Intraperitoneal Multiport Radical Prostatectomy: A Single-Institutional Experience.

OBJECTIVE: To compare the perioperative results and intermediate-term functional outcomes of single port and multiport robotic-assisted laparoscopic prostatectomy by using a propensity-score analysis. MATERIALS AND METHODS: We evaluated all patients who underwent robotic prostatectomy by 3 urologic surgeons at our institution between January 2019 and October 2020. Demographic, intraoperative, and postoperative data were collected and assessed. Patients were matched based on body mass index, Gleason group, and prostate volume using the optimal matching method. RESULTS: Overall, 98 and 165 patients underwent single port and multiport robotic prostatectomy, respectively. Following propensity-score matching, 98 multiport cases were matched 1:1 to single port cases. The median operative time was lower for multiport (111.5 vs 147.0 minutes, P = .0000). Single port had a lower median estimated blood loss (50.0 vs 75.0 mL, P = .0006), pain score on postoperative day 0 (1.0 vs 2.0, P = .0004), opioid use at postoperative day 1 (0.0 [IQR 0.0-5.0] vs 0.0 MME [IQR 0.0-7.5], P = .0058), cumulative opioid use (2.0 vs 7.0 MME, P = .0008), and lymph node yield (4.0 vs 7.0 nodes, P = .0051). Single port had a greater percentage of men regain full erectile function by 6 months (23.8% vs 4.8%, P = .002). CONCLUSION: The single port robotic system is a safe option for localized prostate cancer treatment, offering superior pain control and comparable perioperative results and intermediate-term functional outcomes compared to the multiport robotic approach.

Management of Left Staghorn Calculus With Colorenal Fistula.

Fistula formation between the kidney and the colon is a rare occurrence. Colorenal fistulas have been reported after renal cryoablation, calculous pyonephrosis, and renal cell carcinoma. Fistula formation is reported in as many as 35% of patients with Crohn's disease. Crohn's-related urinary fistulas may include enterovesical, enteroureteral, rectourethral, urethrocutaneous, and entero-urachal fistulas. Here, we report a rare case of a patient who was found to have a left colorenal fistula in the setting of a left staghorn calculus and recurrent urinary tract infections with a question about the eventual definitive management of the patient.

Women neurosurgeons around the world: a systematic review.

OBJECTIVE: Gender disparities in neurosurgery have persisted even as the number of female medical students in many countries has risen. An understanding of the current gender distribution of neurosurgeons around the world and the possible factors contributing to country-specific gender disparities is an important step in improving gender equity in the field. METHODS: The authors performed a systematic review of studies pertaining to women in neurosurgery. Papers listed in PubMed in the English language were collected. A modified grounded theory approach was utilized to systematically identify and code factors noted to contribute to gender disparities in neurosurgery. Statistical analysis was performed with IBM SPSS Statistics for Windows. RESULTS: The authors identified 39 studies describing the density of women neurosurgeons in particular regions, 18 of which documented the proportion of practicing female neurosurgeons in a single or in multiple countries. The majority of these studies were published within the last 5 years. Eight factors contributing to gender disparity were identified, including conference representation, the proverbial glass ceiling, lifestyle, mentoring, discrimination, interest, salary, and physical burden. CONCLUSIONS: The topic of women in neurosurgery has received considerable global scholarly attention. The worldwide proportion of female neurosurgeons varies by region and country. Mentorship was the most frequently cited factor contributing to noted gender differences, with lifestyle, the glass ceiling, and discrimination also frequently mentioned. Future studies are necessary to assess the influence of country-specific sociopolitical factors that push and pull individuals of all backgrounds to enter this field.